Rajiv Gandhi University of Health Sciences s302

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

MRS. SAPNA BHAVIN PATEL

1 YEAR M.Sc. NURSING

OBSTETRICS AND GYNAECOLOGICAL NURSING

(2011-2013 BATCH)

SRI SHANTHINI COLLEGE OF NURSING

#188/B, PARVATHI NAGAR, OPP: SUB REGISTRAR OFFICE,

LAGGERE MAIN ROAD, LAGGERE

BANGALORE- 560058

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

01 / NAME OF THE CANDIDATE AND ADDRESS / MRS. SAPNA BHAVIN PATEL,
1ST YEAR M.Sc. NURSING
SRI SHANTHINI COLLEGE OF NURSING,
#188/B, PARVATHI NAGAR,
OPP SUB REGISTRAR OFFICE,
LAGGERE MAIN ROAD, LAGGERE,
BANGALORE-560058
02 / NAME OF THE INSTITUTION / SRI SHANTHINI COLLEGE OF NURSING,
#188/B, PARVATHI NAGAR,
OPP SUB REGISTRAR OFFICE,
LAGGERE MAIN ROAD, LAGGERE,
BANGALORE-560058
03 / COURSE OF THE STUDY AND SUBJECT / MASTER DEGREE IN NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING
04 / DATE OF ADMISSION TO COURSE / 30/06/2011
05 / TITLE OF THE TOPIC / THE EFFECTIVENESS OF GUIDED IMAGERY TECHNIQUE IN ALLEVIATING THE PREMENSTRUAL SYNDROME

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“The imagination exercises a powerful influence over every act of sense, thought, reason……over every day”

-Latin Proverb

Premenstrual syndrome (PMS) refers to symptoms that occur between ovulation and the onset ofmenstruation. The symptoms include both physical symptoms, such as breast tenderness, backpain, abdominal cramps,headache, and changes in appetite, and psychological symptoms ofanxiety, depression, and unrest. Severe forms of this syndrome are referred to as premenstrual dysphoric disorder (PMDD). These symptoms may be related to hormones and emotional disorders. Approximately 75 percent of all menstruating women experience some symptoms that occur before or during menstruation. Premenstrual syndrome encompasses symptoms severe enough to interfere with daily life. About 3 to 7 percent of women experience the more severe premenstrual dysphoric disorder. These symptoms can last four to ten days and can have a substantial impact on a woman's health. Premenstrual syndrome is a common psychosomatic disorder and about 30%-50% of women in the childbearing age suffer from mild to moderate form of this disorder and 3%-8% suffer from its sever form. The symptoms of this disorder are related to the specific biological characteristics of women's reproductive age that can start from teen years. The symptom’s devastating effect on these crucial years of life can result in a sense of dissatisfaction and inadequacy.1

Imagery had been found to be very effective for the treatment of stress. Imagery is at the center of relaxation techniques designed to release brain chemicals that act as your body's natural brain tranquilizers, lowering blood pressure, heart rate, and anxiety levels. By and large, researchers find that these techniques work. Because imagery relaxes the body, doctors specializing in imagery often recommend it for stress-related conditions such as headaches, chronic pain in the neck and back, high blood pressure, spastic colon, and cramping from premenstrual syndrome. Imagery can also help alter menstrual cycles and relieve symptoms of premenstrual syndrome. In a preliminary study, researchers at Massachusetts General Hospital in Boston found that 12 of 15 women, ages 21 to 40, who used imagery for three months lengthened their monthly menstrual cycles by an average of nearly four days and slashed their perceived levels of premenstrual distress in half. They also reported fewer mood swings.

At the University of South Florida in Tampa, researchers asked 19 men and women, ages 56 to 75, who had chronic bronchitis and emphysema to rate their levels of anxiety, depression, fatigue and discomfort before and after they began using imagery. The researchers concluded that imagery significantly improved the overall quality of these people's lives.2

Advocates of imagery contend that the imagination is a potent healer that has long been overlooked by practitioners of Western medicine. The power of the mind to influence the body is quite remarkable. Although it isn't always curative, imagery can be helpful in 90 percent of the problems that people bring to the attention of their primary care physicians.3

6.1 NEED FOR THE STUDY

The term PMS stands for Premenstrual Syndrome, a familiar acronym used to describe a cyclical challenge with a confusing array of physical, emotional or behavioral responses experienced by an amazingly large number of women every month in the days and even weeks before their menstrual periods begin. In spite of widespread myth and misinformation, the truth about premenstrual syndrome is that it is real as any other legitimately recognized physical condition with a combination of physical and emotional responses that are all too often dismissed as trivial. In fact, premenstrual syndrome responses are known to challenge health, change normal routine and impact lifestyle. 1

Recent studies show that as many as 80% of American women have premenstrual syndrome at some time during the average 400 menstrual cycles occurring between menarche and menopause, or the time between when the menstrual period start at puberty and when it ceases after menopause. Although there is no therapeutic "cure" for premenstrual syndrome, the good news is that there are significant, new advancements in understanding and managing it--break-through that mean improvements in the quality of life for literally millions of women. Though there is no doubt that women suffer from premenstrual syndrome, many endure the discomfort and pain in silence or complain only to family and friends because they do not realize that anything can be done to help them. Not so, but the way premenstrual syndrome is managed depends on identifying specific challenges, when they occur and how severe they are. 2

It is important for a woman to take charge of understanding her premenstrual syndrome patterns and learning about what's happening within her body. Only then can she realistically evaluate their effects on her life and make informed decisions about management.4

Premenstrual syndrome is a complex health concern. Up to 80% of women experience some symptoms of premenstrual syndrome. Scientists cannot agree on its cause or the best way to treat premenstrual syndrome. Around 3-8% of women may have more severe condition called premenstrual dysphoric disorder (PMDD). Premenstrual syndrome and premenstrual dysphoric disorder are not the same. Women with premenstrual dysphoric disorder become seriously depressed for a week or more before their periods. Premenstrual syndrome is shorter, usually milder, and involves more physical symptoms. The two may occur together, or a woman may have one and not the other. There are various management options, all of which need to be carefully monitored because of individual responses. Since both menstrual cycles and premenstrual syndrome responses are variable, caution must be exercised before pronouncing a "cure." The reason for caution is that even the most positive effects can be short lived, and management variation may be required for successful results to continue.5

Guided visualization had also been found to be very effective for the treatment of stress. Imagery is at the center of relaxation techniques designed to release brain chemicals that act as body’s natural brain tranquilizers, lowering blood pressure, heart rate, and anxiety levels. By and large, researchers find that these techniques work. Because visualization and body scanning relaxes the body, doctors specializing in visualization often recommend it for stress-related conditions such as headaches, chronic pain in the neck and back, high blood pressure, spastic colon, and cramping from premenstrual syndrome. 2

Imagery can also help alter menstrual cycles and relieve symptoms of premenstrual syndrome. In a preliminary study, researchers at Massachusetts General Hospital in Boston found that 12 of 15 women, ages 21 to 40, who used imagery for three months lengthened their monthly menstrual cycles by an average of nearly four days and slashed their perceived levels of premenstrual distress in half. They also reported fewer mood swings. Using guided imagery to reduce the severity of Premenstrual syndrome and menstrual pain can lead to increased comfort and decreased absenteeism, without the cost and potential undesirable side effects of some medications. 6

Premenstrual syndrome affects up to 75% of all women with regular menstrual cycle. There are both physical and emotional symptoms, crying spells, irritability, anger that’s hard to control. Clinically significant premenstrual syndrome occurs in 20% of girls and women. In order to reduce the severity of symptoms the researcher has chosen the study.

6.2 REVIEW OF LITERATURE

6.2.1 REVIEWS RELATED TO PREMENSTRUAL SYNDROME

6.2.2 REVIEWS RELATED TO LIFESTYLE CHANGES TO ALLEVIATE SYMPTOMS OF PREMENSTRUAL SYNDROME

6.2.1 REVIEWS RELATED TO PREMENSTURAL SYNDROME

Ziba Taghizadeh et al conducted a study in south of Tehran to determine the correlation between premenstrual syndrome (PMS) and quality of life (QOL) in adolescent girls. The method of the study was a descriptive-analytic study. The participants were 360 adolescent girls (180 in each group), studying in the second year of high school in south of Tehran. The participants were selected in a multistage randomly- clustered design according to their schools. The study revealed that premenstrual syndrome is associated with substantial burden on quality of life in adolescents. In addition, increasing severity in premenstrual syndrome symptoms results in decreased quality of mental health and vitality.7

Borenstein JE et al conducted telephone survey to determine that premenstrual syndrome affects a women’s health related quality of life. 436 women. completed a telephonic survey, Of this group, 125 women had a diagnosis of premenstrual syndrome (PMS) and 311 women did not. When compared with control subjects, the women with PMS scored significantly lower on the mental (P<0.001) and physical (P=0.04) scales of the Medical Outcomes Study Short Form-36, reported reduced work productivity, interference with hobbies and a greater number of work days missed for health reasons (P<0.001), and had an increased frequency of visits to an ambulatory care provider. The investigators concluded that premenstrual syndrome significantly affects a woman’s health-related quality of life and may result in decreased work productivity and increased healthcare costs.8

Rapaport etal studies show that women with premenstrual syndrome report reduced work productivity and more interference with normal daily tasks and greater number of workdays missed for health reasons Studies conducted on depressive and anxiety disorders view premenstrual syndrome as a kind of disorder with noticeable psychological aspect that can negatively affect the quality of life , enjoyment and satisfaction.9

Dean and Borenstein conducted a prospective study in which women, aged 18 to 45 years, were asked to keep a symptom diary using the Daily Record of Severity of Symptoms during two consecutive menstrual cycles. Of the 436 evaluable participants who completed the survey, 78 (17.9%) had one cycle with premenstrual syndrome (PMS), 47 (10.8%) women had two cycles with PMS, and 311 (71.3%) women served as controls. When compared with the control subjects, women with two cycles of premenstrual syndrome were significantly more likely to miss more than 2 workdays per month due to health reasons (P=0.006), have more than 5 day sper month with a 50% reduction in productivity at work (P≤0.0001), and have more than 14 days per month with impairment in work, school, and household activities (P≤0.0001), in social activities and hobbies (P≤0.0001) and in relationships with others (P≤0.0001). 10

Halbereich U et al conducted study results addressing issues in the diagnosis and treatment of premenstrual disorders. Women reported seeking medical treatment for premenstrual symptoms from a mean of 3.75 physicians for a mean of 5.33 years before being diagnosed with premenstrual syndrome (PMS). In one study, 85% of the women surveyed reported that they had tried one or more treatments for premenstrual syndrome, and 45% said that they felt they wanted more help. In another study of women with severe premenstrual symptoms, less than half of them had sought medical treatment, and half did not think any treatment would help. They noted that industry market research data sources estimate that 89% of the women with premenstrual dysphoric disorder are undiagnosed.11

6.2.2 REVIEWS RELATED TO LIFESTYLE CHANGES TO ALLEVIATE SYMPTOMS OF PREMENSTURAL SYNDROME

Many women find that regular aerobic exercise eases the symptoms of premenstrual syndrome. The decline in endorphin levels that normally occurs in the late luteal phase of the menstrual cycle has been suggested as an underlying mechanism for premenstrual symptoms in some women. Regular aerobic exercise leads to the release of endorphins in the central nervous system. The recommendation is that women engage in at least 20–30 minutes of aerobic exercise per day at least three days each week. Several studies indicate that calcium supplements have modest effects on premenstrual symptoms. Limited data indicate a possible benefit for a beverage containing complex and simple carbohydrates. Other recommendations such as reductions in salt, sugar, alcohol and caffeine intake have not been investigated in controlled studies. 12

Cognitive-behavioral therapy (CBT) is a short-term, structured therapy that combines active collaboration between patient and therapist to achieve therapeutic goals oriented toward current problems and their solutions with behavioral techniques that test and change maladaptive and inaccurate cognitions. Several studies have investigated the use of CBT in women with symptoms in the premenstrual phase of the cycle.13

Taylor D conducted an intervention study to determine the short- and long-term effectiveness of a symptom management Intervention to relieve distress associated with severe premenstrual syndrome (PMS). The intervention consisted of self-monitoring, personal choice, self-regulation, and self/environmental modification. Of the 91 women in the study, 40 were in the early treatment group and 51 were in the no-treatment group. Active symptom management reduced premenstrual syndrome severity by 75% and premenstrual depression and general distress by 30% to 54%; it also increased well-being and self-esteem.14

Christensen AP and Oei TP conducted a comparative study to compare the effects of Cognitive Behavioral Therapy (CBT) and information-focused therapy (IFT; i.e., relaxation training, nutritional and vitamin guidelines, dietary and lifestyle recommendations, aspects of child management training, and assertion training) in women with premenstrual dysphoric changes; 24 women were in the CBT group and 9 were in the IFT group. The investigators concluded that both treatments were equally effective in reducing premenstrual levels of negative mood and physical symptoms. The treatment effects were maintained at 12 months.15